Infant Feeding in 20 Developing Countries with Focus on Infant Undernutrition in Cambodia

Abstract

The Demographic and Health Survey (DHS) data provide a strong base for evaluating guidelines for child feeding across multiple countries. Based on DHS data, breastfeeding was widely practiced and a high percentage of mothers continued to breastfeed through the first year of life in 20 countries that were identified by the World Bank as among the poorest economically. However, many mothers in these 20 countries began feeding sweetened liquids and solid food to their babies earlier than recommended by the World Health Organization (WHO). In one of these countries – Cambodia – we compared DHS infant feeding data collected in 2000 to date from 2005 and assessed the WHO core feeding indicators recommended for healthy growth. In Cambodia, fewer children exhibited underweight in most age categories in 2005 than in 2000; however, the prevalence of stunting among 18- to 23-month-old children was not less in 2005 and remained above 50%. In this Cambodian study, prevalence of compliance with all age-based breastfeeding and complementary feeding WHO indicators increased significantly between surveys in 2000 and 2005, except percent of mothers currently breastfeeding at 12–15 months which remained relatively constant (2000: 87.1%; 2005: 89.6%). In particular, among Cambodian 0- to 5-month-old infants, prevalence of exclusive breastfeeding increased fivefold and prevalence of early breastfeeding initiation increased threefold between 2000 and 2005. While prevalence of meeting the WHO complementary feeding indicator for feeding diversity increased between 2000 and 2005, the prevalence remained very low for the WHO indicators of feeding diversity and minimal acceptable diet among various age groups. However, multivariate regression models demonstrated no overall general association of the WHO feeding indicators with undernutrition measures of underweight and stunting. There were some age-specific associations: 0- to 5-month-old infants, whose mothers were in compliance with both exclusive breastfeeding and breastfeeding initiation guidance and were at significantly lower risk of underweight; and 6- to 11-month-old infants, whose mothers were in compliance with the overall solid food guidance and were at significantly reduced risk of stunting but not underweight. Our primary finding from models of the WHO feeding indicators in Cambodia was a consistent positive association of reduction in risk of stunting and underweight with increases in relative wealth. In conclusion, many mothers in developing countries continue to breastfeed their babies through the first 12 months as recommended by the WHO. Among the WHO feeding indicators, focus on complementary feeding, particularly increased diversity of foods among children over 6 months of age, is indicated as a potential approach to reduce the high prevalence of stunting among children over 18 months of age in poor countries.